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What is pancreatitis?

Pancreatitis is an acute or chronic inflammation of the pancreas. Acute attacks are often characterized by severe abdominal pain that radiates from the upper belly through to the back and can cause effects ranging from mild pancreatic swelling to life-threatening failure of many organs. Chronic pancreatitis is a progressive condition that results in permanent damage of pancreatic tissue. Recurrent acute attacks can lead to chronic pancreatitis.

The pancreas is a narrow, flat organ located deep in the abdominal cavity, behind the stomach and below the liver. It has head, middle, and tail sections. Its head section connects to the duodenum, the first part of the small intestine. Inside the pancreas, small ducts (tubes) feed digestive enzymes produced by the pancreas into the pancreatic duct. This large duct carries the digestive enzymes down the length of the pancreas, from the tail to the head section, and into the duodenum. The common bile duct also runs through the head section of the pancreas, carrying bile from the liver and gallbladder into the small intestine. The bile duct and pancreatic duct usually join just before entering the duodenum and share a common opening into the small intestine.

The pancreas has two kinds of tissues: exocrine and endocrine. Exocrine tissues make powerful enzymes that help digest fats, proteins, and carbohydrates in the small intestine as well as make bicarbonate that helps neutralize stomach acids. Endocrine tissues have "islets" or clusters of certain cell types that produce the hormones insulin and glucagon (among other hormones), whihch are vital for the transportation of glucose into the body's cells and for maintaining normal blood levels of glucose (blood sugar).

The cells of the exocrine pancreas make, store, and release digestive enzymes. Many of these digestive enzymes are inactive within the cell but activated when they reach the small intestine. Obstruction of the common bile and pancreatic ducts, most commonly by gallstones, causes an accumulation and early activation of digestive enzymes, leading to pancreatic damage and pancreatitis.

Pancreatitis can also occur without the presence of an obstruction. In addition to the normal stress on pancreatic cells and genetic differences between individuals, external stressors such as alcoholism affect regular pancreatic cell function. The stress may not be sufficient to cause pancreatitis in all individuals, but in certain people, it appears to substantially increase the risk by adversely affecting normal digestive enzyme synthesis and release or by causing early activation of these enzymes. The resulting cell damage leads to cell death and, if the damaging events and inflammatory response are too great or persistent, pancreatitis may develop.

Pancreatitis occurs more frequently in men than in women and is known to be linked to and aggravated by alcoholism and gallbladder disease. In the latter case, this happens because of obstruction of the common duct from the gallbladder and pancreas into the intestine. Obstruction is most frequently due to gallstones and sometimes to biliary sludge. Alcoholism and gallbladder disease are responsible for about 80% of acute pancreatitis attacks and figure prominently in chronic pancreatitis. Another 10% of the time the cause is idiopathic, and the other 10% of the time it is due to one of the following:

Accordion Title
About Pancreatitis
  • Signs and Symptoms

    Acute pancreatitis
    About 75% of acute pancreatitis attacks are considered mild, although they may cause the affected person severe abdominal pain, nausea, vomiting, weakness, and jaundice. These attacks cause local inflammation, swelling, and hemorrhage that usually resolve with appropriate treatment and do little or no permanent damage.

    About 25% of the time, acute pancreatitis attacks are severe and complications can develop, such as tissue death, infection, low blood pressure, difficulty breathing, shock, and kidney or liver failure. Diagnosing and treating severe attacks as soon as possible are critical to prevent complications and to reduce inflammation and limit infection.

    When symptoms develop, it is important to see a health practitioner both because symptom severity does not necessarily reflect the amount of damage that may be occurring and because other conditions that require different treatments may cause similar symptoms.

    Chronic pancreatitis
    People with chronic pancreatitis may have recurring attacks with symptoms similar to those of acute pancreatitis; these attacks often increase in frequency as the condition progresses. The most common symptom observed is pain in the mid-abdomen that may radiate to the mid-back, which usually lasts at least several hours at a time.

    Over time, the pancreatic tissue becomes increasingly scarred and the cells that produce digestive enzymes are destroyed, causing pancreatic insufficiency, weight loss, malnutrition, ascites, pancreatic pseudocysts (sacs of fluid and destroyed tissue that can become infected), and fatty stools. As the cells that produce insulin are destroyed, the affected person may become diabetic.

    Pain with chronic pancreatitis may be severe and continuous or intermittent. It may be made worse with eating/drinking and drinking alcohol.

  • Tests

    According to the American College of Gastroenterology's guidelines, there are three criteria that must be present to diagnose acute pancreatitis, including:

    1. Severe abdominal pain
    2. Amylase or lipase levels that are three times higher than the upper limit of normal
    3. "Characteristic" abdominal imaging results

    Chronic pancreatitis may also be diagnosed using these tests as well as others.

    More about the tests used for both types of pancreatitis:

    • Amylase is the pancreatic and salivary gland enzyme responsible for digesting carbohydrates. The level will increase 2 to 12 hours after the beginning of symptoms of acute pancreatitis and peaks at 12 to 72 hours afterward. It may rise 5 to 10 times the normal level and will usually return to normal within a week. Pancreatitis is likely if the level reaches 3 times above the upper limit of normal. Amylase also may be monitored in people with chronic pancreatitis; it will often be moderately elevated until the cells that produce it are destroyed (as a result of the pancreatitis), at which point blood levels of amylase may be decreased. It should be noted that amylase is an enzyme that has different forms called isoenzymes: P-amylase refers to the form made by the pancreas and S-amylase refers to the form made by the salivary glands. Normally, a total amylase test is requested. Sometimes, the isoenzyme tests are requested individually to distinguish pancreatic and non-pancreatic causes of increased amylase.
    • Lipase is the pancreatic enzyme that, along with bile from the liver, digests fats.  It is another test commonly used to diangose pancreatitis. Its level increases in the blood within 4 to 8 hours of the beginning of an acute attack and peaks at 24 hours afterward. Lipase is both more sensitive and more specific than amylase for the diagnosis of acute pancreatitis. However, there are other sources of lipase in the digestive tract. In some assays that detect non-pancreatic lipase, milder elevations may occur as a result of non-pancreatic disorders. In people with pancreatitis, lipase may rise to several times its normal level and remain elevated longer than amylase. Like with the amylase test, pancreatitis is diagnosed if the lipase level reaches 3 times above the upper limit of normal. As cells are destroyed with chronic pancreatitis and as lipase production drops to less than 10% of the normal level, steatorrhea (fatty, foul-smelling stools) will form. As chronic pancreatitis progresses, amylase and lipase may be normal or decreased, even during acute attacks.
    • Trypsin is the pancreatic enzyme that digests proteins. Measurement of serum trypsin is thought to be the most sensitive blood test for pancreatitis, particularly chronic pancreatitis, but is not widely available and is not routinely used. The available test is variably identified as trypsinogen, trypsin-like immunoreactivity, or immunoreactive trypsin.


    Tests that may be used to check for complications of acute pancreatitis include:


    Other tests that may be used to help diagnose and evaluate chronic pancreatitis include:


    Non-laboratory tests used to diagnose pancreatitis may include:

    • Abdominal ultrasound
    • Endoscopic retrograde cholangiopancreatography (ERCP): a test that uses a flexible scope inserted through the mouth and threaded through the esophagus to see and document damage to the pancreas and/or bile ducts
    • Magnetic resonance cholangiopancreatography (MRCP): a type of magnetic resonance imaging (MRI) used to image the pancreas and bile ducts; often used before or instead of ERCP because it is faster and non-invasive; also useful in distinguiding pancreatitis from pancreatic cancer
    • Computed tomography (CT) scan
    • Secretin testing (not widely available) in which a tube is positioned in the duodenum to collect pancreatic secretions stimulated by intravenous (IV) administration of secretin. Secretin is a hormone that causes the pancreas to release fluid containing digestive enzymes. The amount of enzymes, such as lipase and trypsin, and bicarbonate in the pancreatic secretion is measured and compared to normal values.


    For more information on imaging studies, visit RadiologyInfo.org.

  • Treatment and Prevention

    Pancreatitis demands prompt medical attention. During an acute attack, there is the potential for the pancreas to be destroyed within a matter of hours and complications can be life-threatening.

    Acute Pancreatitis
    It usually is not possible to prevent most single incident acute pancreatitis attacks or to detect them early. Recurrent acute pancreatitis may be caused by a combination of genetic risk and modifying factors, such as alcoholism. Attacks associated with alcoholism, typically involving several years of moderate to heavy alcohol consumption, are usually precipitated by an episode of binge drinking. There may or may not have been earlier warning pains that could have been addressed by seeking medical attention. In the case of gallstones or other causes of acute pancreatitis, there usually is no warning before the attack.

    Treatment usually consists of pain control and fasting to "rest" the pancreas for several days to a few weeks until symptoms subside. People are hospitalized during this time period, and all fluids and nutrition are given intravenously (IV). Complications such as infections are monitored and treated. If the acute pancreatitis is due to gallstones, surgery may be necessary, including removal of the gallbladder.

    Chronic Pancreatitis
    Chronic pancreatitis is treated by trying to prevent future attacks, minimizing pancreatic damage, and by addressing damage already done. Abstention from alcohol is critical in helping to prevent additional attacks. A low-fat diet may be prescribed to reduce the burden on the pancreas and pancreatic enzymes may be given to alleviate insufficiencies and malabsorption. The affected person also may need to supplement their diet with fat-soluble vitamins and calcium. Glucose (blood sugar) is often monitored, and insulin injections may be given if the person has become diabetic. Oral diabetic medications do not usually work in these cases.

    Pain control is an important part of treatment as there may be ongoing moderate to severe pain. Those affected may be given narcotics and antidepressants. As time progresses and pancreas function diminishes due to destruction of pancreatic tissues, the pain level may drop.

    Surgery may be necessary in some cases to remove all or part of the pancreas and/or to remove or bypass obstructions. It should be noted that the pancreas is very difficult to operate upon. Read more about pancreatic surgery at the American Cancer Society website.

    Those with chronic pancreatitis are at a higher risk for developing pancreatic cancer. As a health practitioner monitors someone with chronic pancreatitis, he or she also will be watching for cancer.

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